Cherokee Nation Prevention Trial: Interactive Effects of Environment & SBIRT

描述（由申请人提供）：拟议的项目是预防科学家和切罗基国家行为健康服务机构之间的合作伙伴关系，旨在创建、实施和评估一种新的综合社区一级干预措施，旨在防止未成年人饮酒和生活在农村高风险服务不足社区的美国印第安人和白人青年的相关负面后果。这项试验将在俄克拉荷马州东北部进行，这是一个贫困率高、健康差距大的地区。提出的干预措施直接建立在多个先前实验的结果上，这些实验采用两种不同的方法-社区环境变化和短暂干预和转诊-单独评估和使用析因设计组合评估。直接行动社区组织，在以前的多个随机试验中被证明是有效的，将用于解决与青少年酒精使用和商业和社会获取酒精有关的社区问题。我们对简短干预的设计和实现与典型的实现有着根本的不同。我们将设计一个社区范围的SBIRT干预，而不是在选定的有限数量的诊所、急诊科或学校实施SBIRT。人口层面的简短干预将包括五个关键组成部分：(1)简短的一对一筛选和动机访谈会议，(2)看门人培训，(3)同伴领导培训，(4)家庭明信片活动，(5)社区范围的媒体活动。五个关键的研究设计要素优化了干预效果的因果推理和实验评价：(1)控制中断时间序列设计，(2)随机选择城镇，(3)随机分配研究条件，(4)析因设计，(5)多个对照组。这个随机试验的主要设计特点是一个受控的中断时间序列设计。大量的重复测量（时间序列）大大增加了内部效度（即因果推理的强度）以及传统的社区试验前后设计的统计能力。重复评估将衡量每个干预组成部分的实施保真度，并通过调查、观察和档案来源衡量关键的近端和主要的最终结果。主要研究样本将包括研究城镇内的所有高中生。每周和每月的测量将产生一个时间序列设计，其中观察了四年期间在城镇内筑巢的年轻人。除了重复的横断面样本外，我们还将使用参与者标识符来跟踪四年来嵌入的队列。这一创新项目涉及已建立的预防科学家和切罗基民族行为健康服务机构领导人之间的牢固伙伴关系，有可能改变预防酒精的研究和实践。尽管近几十年来在预防科学和实践方面取得了进步，但美国仍在与青少年中与酒精相关的重大风险和后果作斗争。拟议的项目将对一项新的综合性社区一级预防干预措施进行严格评估。

DESCRIPTION (provided by applicant): The proposed project is a partnership between prevention scientists and the Cherokee Nation Behavioral Health Services to create, implement and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among American Indian and white youth living in rural high-risk underserved communities. This trial will take place in northeastern Oklahoma, an area suffering from high rates of poverty and substantial health disparities. The proposed intervention builds directly on the results of multiple previous experiments with two distinct approaches-community environmental change and brief intervention and referral-evaluated alone and in combination using a factorial design. Direct- action community organizing, documented as effective in multiple previous randomized trials, will be used to address community issues related to alcohol use and commercial and social access to alcohol among adolescents. Our design and implementation of brief interventions differs in a fundamental way from typical implementations. Instead of SBIRT implemented in select limited numbers of clinics, emergency departments or schools, we will design a community-wide SBIRT intervention. The population-level brief interventions will include five key components: (1) brief one-on-one screening and motivational interviewing sessions, (2) gatekeeper training, (3) peer leader training, (4) family postcard campaign, and (5) community-wide media campaign. Five key research design elements optimize causal inference and experimental evaluation of the intervention effects: (1) a controlled interrupted time-series design, (2) random selection of towns, (3) random assignment to study condition, (4) a factorial design, and (5) multiple comparison groups. The primary design feature of this randomized trial is a controlled interrupted time-series design. The large number of repeated measures (a time-series) substantially increases internal validity (i.e., strength of causal inference) as well as statistical power over conventional pre/post community trial designs. Repeated assessments will measure implementation fidelity for each intervention component, and measure key proximal as well as the primary ultimate outcomes through survey, observation and archival sources. The primary study sample will include all high-school students within study towns. Weekly and monthly measurements will produce a time-series design with observations of youth nested within town over the four-year period. In addition to repeated cross-sectional samples, we will use participant identifiers to track the embedded cohorts over the four years. This innovative project, involving a strong partnership between established prevention scientists and leaders of the Cherokee Nation Behavioral Health Services, has the potential to transform alcohol prevention research and practice. Despite advances in prevention science and practices in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth. The proposed project will provide a rigorous evaluation of a new, integrated community-level preventive intervention.